tbuckley/cabot-search huggingface dataset:
Quality of cancer care in a low-resource setting: A single-center observational study.
Authors: Musliu Adetola Tolani, Isaac Gundu, Emeka Stanley Nwabuoku, Shehu Salihu Umar, Amina Ibrahim Dansani, Bashir Abubakar Dauda
Journal: Journal of Clinical Oncology (2022)

e18622 Background: There are challenges in access to healthcare in developing countries. The quality of care is however an important consideration in achieving sustainable positive outcomes during patient management. This study, therefore, aimed to assess this measure of cancer care in our setting. Methods: A cross-sectional study of sixty-three patients with malignancy, who had or were planned for cancer treatment, was performed. Information on their demographic and clinical characteristics were obtained. Quality of cancer care was measured using the Consumer Assessment of Healthcare Providers and Systems instrument. SPSS was used for data analysis and p-value &lt; 0.05 was considered significant. Results: Their average age was 60.0 (43.8 – 69.3) years. Twenty (31.7%) had gastrointestinal malignancy while 17 (27.0%), 15 (23.8%) and 11 (17.5%) had prostate, breast and cervical cancer respectively. The median duration since cancer diagnosis was 4.0 (2.0 – 14.0) months. Regarding support provided by the care team to manage the cancer and the effects of its treatment; majority of the respondents, 30 (54.5%), answered in a negative tone. Similarly, the majority of the respondents did not select the maximum score on the scale in the aspects of receiving timely appointments, care, and information; communication between the cancer care team and patients; information use for care co-ordination; and the availability to give information when required (Table). Despite this, patient rating of their cancer care team and their overall experience was 8.0 ± 1.8 and 7.8 ± 2.0 respectively. There was however a significant difference in the latter between those who had cancer recurrence in comparison to those who did not experience this event (6.8 ± 2.2 versus 8.2 ± 1.7, p = 0.048). Conclusions: Even though the general rating of the experience of these patients was high; the gaps highlighted in the areas of patient support, communication and navigation and their sub-optimal experience during cancer recurrence could be further improved to enhance the delivery of cancer care in this limited resource setting.[Table: see text]
The impact of clinical trial enrollment on specialty palliative care utilization in pediatric patients with high-grade gliomas.
Authors: Holly Roberts, Andrea Flynn Franson
Journal: Journal of Clinical Oncology (2022)

10057 Background: In pediatric oncology patients, palliative care has been shown to provide numerous benefits, including less intense clinical care in the last month of life, improved symptom management, and dedicated family communication. Pediatric patients with high grade glioma (HGG) represent a patient population particularly well suited for early involvement of palliative care given their high symptom burden and relatively poor prognosis. However, a recent study revealed that pediatric patients with primary malignant central nervous system (CNS) tumors missed multiple opportunities for appropriate palliative care involvement throughout their disease courses. We hypothesize that clinical trial enrollment may lead to a lack of or delay in involvement of palliative care in children and young adults with HGG. Methods: We identified a cohort of 43 deceased pediatric patients with HGG who received care at our institution. IRB exemption was obtained. For each patient, the electronic medical record was reviewed to collect patient demographics, cancer diagnoses and outcomes, clinical trial enrollment, non-clinical trial treatments, and palliative care involvement. Statistical analysis was performed comparing patients enrolled in trials to those not enrolled, employing Fisher’s exact tests for categorical data and t tests for numerical data. Results: Overall, 72% (31/43) of patients had at least one visit with a specialty palliative care provider. 56% (24/43) of patients enrolled in a clinical trial with HGG-directed therapy. 71% (17/24) of patients who enrolled in a clinical trial received specialty palliative care compared to 74% (14/19) of non-trial participants (p = 1.000). Similarly, among patients who received palliative care there was no statistically significant difference in the timing of palliative care involvement, measured from the date of first palliative care contact to date of death, for patients who enrolled in a clinical trial (mean = 177 days) compared to those who did not (mean = 113 days, p = 0.180). Of the 24 patients enrolled in clinical trials, only 7 (29%) had palliative care involvement prior to initiation of study treatment. Conclusions: As our understanding of the genomic landscape of pediatric brain tumors increases, it can be expected that patients electing to enroll in targeted therapy clinical trials will also increase. As such, it is reassuring that our data suggest that trial participation does not interfere with the receipt of specialty palliative care in children with HGG. While not statistically significant, initial palliative care involvement trends toward occurring in closer proximity to death in the patients who are not enrolled on a clinical trial. Overall, it is encouraging that in our pediatric HGG patient cohort, enrollment in clinical trials does not appear to have an adverse impact on specialty palliative care involvement.
Comparison of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy in the treatment of Borrmann type IV gastric cancer.
Authors: Xingmao Huang, Yu Pengfei, Jingquan Fang, Yang Cao, Zeyao Ye, Tengjiao Chai, Yian Du, Xiangdong Cheng
Journal: Journal of Clinical Oncology (2022)

e16064 Background: Borrmann type IV gastric cancer is highly malignant and prone to peritoneal metastasis, including peritoneal dissemination (P1) and positive peritoneal cytology (CY1) causing a dismal prognosis. This study is to compare the efficacy of neoadjuvant chemotherapy and postoperative adjuvant chemotherapy in patients with Borrmann type IV gastric cancer and analyze the prognostic factors of these patients. Methods: According to different therapies, patients diagnosed with Borrmann type IV gastric cancer in Zhejiang Cancer Hospital from June 2010 to June 2020, were divided into two groups: neoadjuvant chemotherapy group (NCT group) and non-neoadjuvant chemotherapy group (NNCT group). Both of two groups were subjected to the propensity score matching (PSM) at a ratio of 1:2 and then the treatment completion rate and overall survival (OS) time were analyzed. Results: A total of 240 cases were included after propensity score matching and 80 patients and 160 patients were enrolled in the NCT group and NNCT group, respectively. Neoadjuvant chemotherapy and postoperative adjuvant chemotherapy were based on platinum combined with fluorouracil. For the efficacy of treatment, R0 resection was performed on 92.2% patients in the NCT group and 88.1% in the NNCT group, but there was no statistical difference (P=0.463). 3-year survival rate was 35.0% in the NCT group compared with 29.4% in the NNCT group (P=0.427), and the 5-year survival rate was 28.7% and 25.6%, respectively (P=0.460). For patients with and without R0 resection, the 3-year survival rate was 34.3% and 7.4% (P&lt;0.001), and the 5-year survival rate was 30.0% and 0%, respectively (P&lt;0.001). Hyperthermic intraperitoneal chemotherapy (HIPEC) was conducted on 40 patients (16.7%), and the survival rate of HIPEC group was better than that of non-HIPEC group (3 year survival rate: 55.0% vs 26.5%, P=0.073; 5 year survival rate: 45.0% vs 23.0%, P=0.174), but the difference was not statistically significant. Conclusions: Borrmann type IV gastric cancer was characterized by poor differentiation and high incidence of peritoneal metastasis. The efficacy of the neoadjuvant chemotherapy based on platinum combined with fluorouracil is limited. A combination of HIPEC and system chemotherapy may effectively improve the prognosis of these patients.
The influence of blinded independent central review on subject eligibility in oncology studies.
Authors: Larissa Borys, Matthew Marini, Edwin Lu, Robert Ford
Journal: Journal of Clinical Oncology (2022)

e13603 Background: Oncology clinical trials that use imaging based surrogate endpoints such as Progression Free Survival (PFS) and Overall Response Rate (ORR) generally have eligibility criteria based on imaging. Examples include but are not limited to the presence of a RECIST measurable lesion at baseline for studies where ORR is the primary endpoint, the absence of disease at baseline in recurrence studies, the absence of exclusionary brain metastases, and the presence or absence of a particular stage of disease at baseline, such as the absence of T4b, M1, and &gt;N2 disease in studies of muscle invasive bladder cancer. Our experience suggested the percentage of subjects who did not meet those criteria during Blinded Independent Central Review (BICR) may be higher than expected and could have a significant effect on the statistical power of studies. We reviewed a large cohort of subjects (n = 8746) to determine the fraction of subjects who were considered for enrollment or enrolled in oncology clinical trials by investigators and were deemed ineligible during BICR. Methods: We analyzed 66 trials with a total of 8,746 total subjects. Trials were selected based on initiation between June 2020 and June 2021 and involvement of one (1) or more imaging eligibility criteria. Trials in this cohort fit into 2 categories: those that had prospective real time eligibility review where subjects could not be enrolled until the eligibility review was completed in real time (“eligibility review trials”) and those trials that did not have a prospective eligibility review however the data was available for retrospective analysis (“efficacy only trials”). Our analysis determined the fraction of subjects that were prospectively and retrospectively ineligible under each respective category. Results: In these categories, 56% of the subjects (n = 4934) were involved in efficacy only trials. Following BICR review, 12% (n = 614) of the subjects were found to be ineligible retrospectively. Conversely, 44% of the subjects (n = 3812) were enrolled in trials where Clario performed a prospective eligibility review. We found that only 89 of those subjects were deemed ineligible at the time of the prospective eligibility review (2%). This translates to 2% of the subjects were deemed eligible by the investigators, but ineligible by the Clario review. The 10% difference suggests that the eligibility review prevents inclusion of a significant number of subjects that are subsequently determined to have not met the initial imaging eligibility requirements. Conclusions: Eligibility review appears to improve standardization of subject eligibility. These data suggest that the omission of an eligibility review can cascade into censoring more than 10% of subjects. This could have significant impacts on the statistical power of a study and should be considered during study designs.
Child poverty and children entering care in England, 2015–20: a longitudinal ecological study at the local area level
Authors: Davara L Bennett, Daniela K Schlüter, Gabriella Melis, Paul Bywaters, Alex Alexiou, Ben Barr, Sophie Wickham, David Taylor-Robinson
Journal: The Lancet Public Health (2022)

BackgroundChildren in care face adverse health outcomes throughout their life course compared with their peers. In England, over the past decade, the stark rise in the number of cared-for children has coincided with rising child poverty, a key risk factor for children entering care. We aimed to assess the contribution of recent trends in child poverty to trends in care entry.MethodsIn this longitudinal, ecological study of 147 local authorities in England, we linked data from the Department for Work and Pensions and HM Revenue & Customs on the proportion of children younger than 16 years living in families with income less than 60% of the contemporary national median income, before housing costs, with Department for Education data on rates of children younger than 16 years entering care. Using within-between regression models, and controlling for employment trends, we estimated the association of changing child poverty rates with changing care entry rates within different areas. Our primary outcome was the annual rate of children younger than 16 years starting to be looked after by local authorities in England.FindingsBetween 2015 and 2020, controlling for employment rates, a 1 percentage point increase in child poverty was associated with an additional five children entering care per 100 000 children (95% CI 2–8). We estimate that, over the study period, 8·1% of the total number of children under the age of 16 entering care (5·0–11·3) were linked to rising child poverty, equivalent to 10 351 (6447–14 567) additional children.InterpretationWe report evidence that rising child poverty rates might be contributing to an increase in children entering care. Children's exposure to poverty creates and compounds adversity, driving poor health and social outcomes in later life. National anti-poverty policies are key to tackling adverse trends in children's care entry in England.FundingNational Institute for Health Research (NIHR) School for Public Health Research, NIHR Public Health Policy Research Unit, Swedish Research Council, Wellcome Trust, Medical Research Council, and NIHR Applied Research Collaboration North West Coast.
Impact of next-generation sequencing (NGS) on the diagnosis of gliomas according to the WHO-2016 and WHO-2021 classification in routine clinical practice.
Authors: Javier Diaz-Santos, Alexandra Cantero-Gonzalez, Marta Muñoz-Ayllon, Lucia Garrido-Almazan, Cristina Garcia-Gonzalez, Antonio Rueda Dominguez
Journal: Journal of Clinical Oncology (2022)

e14022 Background: The WHO-2016 classification of central nervous system tumors introduced molecular data to perform the diagnosis, especially in gliomas. The cIMPACT-NOW updates and the WHO-2021 classification have consolidated this need, and today a comprehensive structured diagnosis is indicated. Therefore, we study the impact of the use of NGS in changing the diagnosis of gliomas in routine clinical practice. Methods: We have carried out a systematic search of glioma patients operated between January 2008 and September 2021 and diagnosed according to WHO-2016 and cIMPACT-NOW updated criteria at our academic medical center in Spain. All included patients were reclassified to WHO-2021 according to pathological data. Subsequently, we analyzed whether the application of NGS led to a change in the WHO-2016 or WHO-2021 diagnosis. We also analyzed the median of tumor mutation burden (TMB), variants of unknown significance (VUSs), potential enrollment eligible (PENs) and cancer-related alterations (CRAs). Results: Although our center serves a population of 1.8 million people, the scarcity of biopsied material and the difficulty of accessing NGS early enough limited the recruitable patients to 22. Of them 17 patients (77.27%) remained after NGS results with the same WHO-2016 and WHO-2021 diagnosis and in 5 (22.73%) it involved a change in diagnosis (Table). No PENs were detected for any patient. A median of 4 CRAs and 6 VUSs were detected per patient. The median TMB was 1.89 mutations per megabase. Conclusions: The scarce quality biopsied material and the limited access to NGS restrict its use in gliomas. Despite this, its impact in diagnosis cannot be ignored, in our study the diagnosis changed in 1 out of 3.18 patients regardless of the classification used. With these data we recommend increasing the effort to facilitate NGS to glioma patients early enough. Further studies remain essential to determine the impact of NGS results in treatment.[Table: see text]
Coordination‐Driven Metal‐Polyphenolic Nanoparticles toward Effective Anticancer Therapy
Authors: Di Wu, Bin Zhou, Jing Li, Xinyi Wang, Bin Li, Hongshan Liang
Journal: Advanced Healthcare Materials (2022)

Stabilization of bioactive components, especially for hydrophobic functional factors, is a promising approach for improving their biological activity. Here, a metal-phenolic coordination chemistry that synthesizes biocompatible and biodegradable thin film based on tannic acid and trivalent metal ion (Fe3+ or Al3+ ) is addressed, and the results also demonstrate its use for encapsulating a hydrophobic drug (nobiletin) and triggering drug release for cancer treatment both in vitro and in vivo. This assembled system provides drug-loaded nanoparticles (NPs) with small, but uniform, size (≈200 nm). It displays beneficial potential in enhancing colloidal stability and preventing premature drug leakage. Moreover, the metal-phenolic coating is found to possess high cell biocompatibility as a delivery vector for controlled drug delivery, while the final fabricated drug NPs have effective anti-tumor activity by both inducing higher tumor apoptosis and inhibiting tumor metastasis, which is superior to naked drug formulations. Overall, these findings propose an effective and straightforward way for coating hydrophobic drugs employing interfacial adhesion and assembly, which can be a highly promising vehicle for controlled-release biomedical applications for cancer therapy.
LGG-53. Evaluation of KIAA-BRAF1549 fusions in pilocytic astrocytoma with clinicopathological correlation
Authors: Iman Dandapath, Dr Swati Mahajan, Dr Saumya Sahu, Dr Mehar Chand Sharma, Dr Ashish Suri, Dr Vaishali Suri
Journal: Neuro-Oncology (2022)

Abstract Background Pilocytic astrocytomas (PAs) are the primary tumors most frequently found in children and adolescents, accounting for 5.4% of all gliomas. The overall prognosis of PAs is good, yet a substantial no of cases have a poor outcome, with recurrence, and ultimately death. The KIAA1549-BRAF fusion is a useful putative diagnostic marker for PAs and BRAF also is an important therapeutic marker. Aim and Objectives To study the frequency of KIAA1549-BRAF fusion (16-9, 15-9 and 16-11) in different locations of PAs using qRT-PCR technique in FFPE samples. Methodology Three different exon rearrangements of KIAA1549-BRAF (16-9, 15-9 and 16-11) fusions were assessed in 50 cases of PAs by using qRT-PCR (gold standard). FISH assay was also performed in all the cases. Results Out of 50 PAs, 32 were localised in midline structures such as the cerebellum, optic pathway, hypothalamus, and brain stem while 18 in non-midline regions like the cerebral hemispheres. Majority of the cases (35/50); 70% were positive for KIAA1549-BRAF fusion by RT-PCR. Of these, (16/35); 45.7% harboured 15-9 fusion, (15/35); 42.8% harboured 16-9 fusion, and only (4/35); 11.4% had 16-11 fusion. Only (24/30); 48% KIAA1549-BRAF showed fusion by FISH assay. There was 54.2% concordance between FISH and RT-PCR results. KIAA1549-BRAF fusion was observed in 78% of midline and 55.5% of non-midline cases. The frequency of KIAA1549-BRAF fusion decreased with increasing age, 77% in the age group &amp;lt;20, 54% in the age group 20-40 and 30% in the age group &amp;gt;40. Conclusion 15-9 and 16-9 KIAA1549-BRAF were the most frequently occurring fusions dominantly seen in the midline. The presence of fusion is inversely proportional to the age of patients. qRT-PCR is the gold standard technique and FISH assay has moderate concordance with qRT-PCR platform.
Ramucirumab, avelumab, and paclitaxel (RAP) as second-line treatment in gastro-esophageal adenocarcinoma, a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie (AIO).
Authors: Peter C. Thuss-Patience, Anica Högner, Eray Goekkurt, Michael Stahl, Albrecht Kretzschmar, Bärbel Schädlich, Thorsten Oliver Goetze, Gertraud Stocker, Peter Reichardt, Frank Kullmann, Daniel Pink, Prisca Bartels, Alexej Ballhausen, Armin Jarosch, Axel Hinke, Mascha Binder, Alexander Stein
Journal: Journal of Clinical Oncology (2022)

4051 Background: Combination of ramucirumab and paclitaxel is a standard second line therapy in gastro-esophageal adenocarcinoma (GEAC) (RAINBOW trial, Wilke et al., 2014). We integrated the PD-L1 inhibitor avelumab into this regimen aiming for synergistic efficacy. Methods: In a multicenter phase II trial (NCT03966118) pts with metastatic GEAC, after progression on platinum / fluoropyrimidine based palliative 1 st -line, ECOG 0 or 1, were treated with ramucirumab 8 mg/kg (d1,15) + avelumab 10 mg/kg (d1,15) + paclitaxel 80 mg/m² (d1,8,15), q4w. Sample size calculation was based on a Simon 2-stage design with overall survival rate at 6 months as the primary endpoint (H0≤50%, H1≥65%). Results: 60 pts were enrolled, 59 were evaluable (ITT), median age 64.0 yrs (range 18-81), male 80%, female 20%, primary gastric 52%, GEJ 48%, histology intestinal 59.6%, diffuse 24.6%, mixed 15.8%. Previous treatment with platin/fluoropyrimidine 100%, previous taxanes 66%. At central pathology MSI-H 7%, PD-L1 CPS &lt; 5: 54%; ≥5: 41%, NA 5%. Response by investigator (%) CR 3.4, PR 27.1, SD 49.2, PD 20.3; DCR 79.7%, independent radiology review will be presented. DOR: 8.2 mo (95%CI 6.7-9.7), PFS 5.4 mo (95%CI 4.2-6.6); 6-mo OS rate 71.2%; 12-mo OS rate 45.8%; med OS (ITT) 10.6 mo (95%CI 8.2-13.1), med OS CPS &lt; 5: 9.4 mo (95%CI 7.2-11.2), CPS ≥5: 14.0 mo (95%CI 12.8-15.3), translational data (ct-DNA) will be analysed. Treatment was generally well tolerated and no unexpected toxicities occurred: Grade 3/4 AE above 5%: anemia 5%, leucopenia 12%, neutropenia 22%, diarrhea 5%, pain 10%, peripheral neuropathy 10%, hypertension 5%, non-neutropenic infection 5% including 1 CTC grade 5 due to an esophago-tracheal fistula. Conclusions: The med OS of 10.6 mo (in a population of 66% pretreated with taxanes) compares very favourably to 8.6 mo in the Western population RAINBOW trial (Shitara et al., 2016) and 7.6 mo in the RAMIRIS trial (Lorenzen et al., 2022). PD-L1 CPS≥ 5 seems to predict for an even better efficacy (med OS 14.0 mo). Second-line RAP is a very efficacious and well tolerated combination. Clinical trial information: NCT03966118.